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08-8152
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2008
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08-8152
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Last modified
3/6/2009 4:44:21 PM
Creation date
9/23/2008 9:54:45 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
08-8152
Building Department - Name
ELKS LODGE
Address
6851 WIRE RD
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<br />Aug 05 08 11 :21a <br /> <br />James Clouser <br /> <br />727-584-8341 <br /> <br />p.4 <br /> <br />ACORD.. CERTIFICA TE OF LIABILITY INSURANCE OPID P1 I DATE~1 <br />WSCIN-J. osloslos <br />I'ROOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />wa1~ace We1cb & Wi1J.ingham Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />300 rixst Avenue South, 5th Fl HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P.O. Sex 33020 Ai. TER THE COVERAGE AFFORDED BY THE POLICIES BEL.OW. <br />st. Petexsbuxg r.L 33733 j INSURERS AFFORDING COVERAGE <br />Phone: 727-522-7777 Fax: 727-52J.-2902 NAIC. <br />INSURED i~RA: -...." I_t;y XIl.uz._ Co <br /> INSURER 8: r1o..1a. ..1;&11 r~."1DD SIr <br /> WSC XI1Itc:1:iOn services, LLC i INSlJlER c, <br /> 208 Tr ic Blvd & :~RO: <br /> Largo 33'770 ;~RE: <br /> <br />------~-- <br /> <br />w:.......-, ...._ <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS'JED TO THE IiIISURED NMIEO ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />~y REOUIREM9IT, TERM OR CONDITION OF IlNY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHIOi THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFOR:>ED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS. EXClUSIONS AND CONDITIONS OF SUOi <br />POLICIES, AGGREGATE lIMITS SHO,^,,< MAY HAVE BEEN REDliCEO BY PAID ClAIMS. <br />LTR INSR TYPE OF tNSURNCE POLICY__ I~~N DATE IMIlIlID i IJIIITS <br /> GENERAL LIAIIUTY r EACli <lCOJI(RENCE $1000DOO <br />A X ~RCW. GENERAl. LIABILITY 51GL00335307J. 09/13/07 09/J.3/08 I ~S(&~",:;'llIlC&) $ 5000D <br /> ClAlMSMl\OE ~ OCctR I MEt> EJ(p {Any one persml $ 5000 <br /> tj , PERSCH\i. & t>Dl/ II\l.AJRY $ 1000DOO <br /> GEtERi't. AGGREGATE 52000000 <br /> GEI'I'l AGGREGATE LIMIT .'lPPLIES PER: I'f!OOUCTS - COWICP AGG 52000000 <br /> IF'Ol.lcy-H~ nlOC <br /> AUTOMOBIL.E LIA8LfTY CCMlINED S!l<<>lE lWlT <br /> - (Euccioter1l) S <br /> f'H'( "'-""0 <br /> - <br /> ALL OWNED AUTOS 8ttJIl y 1JII.Ur( <br /> - (Pet JMnClOJ $ <br /> SCHEOLlEl AUTOS <br /> - <br /> HREO AI.1TOS 8()[)Il Y 1N.ARr <br /> - S <br /> NON.O'MED ,",UTOS (Pet 1ICdclenI) <br /> - <br /> - PROPERTY Oi\MAGE $ <br /> (Per aa:iclllll) <br /> c:ARAGE L-.sTV AUTO ClHL. y . EA ACCIDENT S <br /> R f'H'( "'-""0 OlliER 1H'IN EAN:.c $ <br /> AtJfO ClHL. Y: AGG S <br /> EIlCESSlUMBRELLA LIABilITY EACH OCOJRRENCE S <br /> tJ CCCLfl o CLAt.IS w.JE AGGREGllTE $ <br /> f <br /> R Caxx:J1flLE S <br /> flElEHTlON $ S <br /> WORKERS COMI'BaAl1ON N(O rTCRY LIMITS I IUJ:t <br />B EliIPLDYERS' L.lA8ll1TY 52035051 12/J.5/07 12/15/08 E.L, EAOi ACCIDENT S 10000D <br />NI'f PROPflIETORiPARTNERiEl<EOJTIVE <br /> Cf'FICERIIo1EMBER ExClUCEO? E.L_ OISEASE . EA ENPlOYEE S 100000 <br /> II v.... descnbo under S 500000 <br /> SPECIAl. PROVISICNi 11_ E.L.OISEASE - POliCY lMT <br /> OTtER <br />DESCRII'TlON OF Ol'ERATlONS I LOCATIONS I Vl!HCLES I EllCL.USIDNS ADDEO 8'1' ENCORSEII!NT I SPECIAL 1'R0'0tS1CNS <br />~ire sprinkler system and domestic backf10w iDapection, service and xepair. <br />City of Bephyhi11.s is ac:klit.ioDa~ insured wi ~h respect to GeDeral. Liabil.i ty <br />if xeqaixed by w.Eit~ coDtxact. <br /> <br />CERTIFICA.TE HOLDER <br /> <br />CANCELLATION <br /> <br />City of Bephyrhil.ls <br />Bui~dinq Department <br />5335 - 8~b S~rcc~ <br />Zephyxbi~1a, rL 33542 <br /> <br />St40ULO AtN OF nee ABOYf! DESCIUIIEO ",,-IClES Be CANr;E\.LB) HFOftE THE EXP!RATION <br />DAn: 'THEREOF. THE IS8UINC INBURSt WILL ENDEAVOR TO MAL ~ DAYS WJUnEN <br />NOTICE TO l1tE a;~1CAlIi HOL.OER NAIIIiD TO THE LEFT, BUTFIoII.URE TO DO SO SH.\L.L <br />_OlE NO OBUCAnON OR LIABILIT'I' OF "IN KIND U,.OH THE INIIL.IlEllITll AGen'8 OR <br />_RE'ENT"TlYEs. <br />II, AeSE <br /> <br /> <br />. ACORD CORPORATION 19BE <br /> <br />ACORD 25 12001/08) <br />
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